Bleeding, Shock, and Soft Tissue Injuries in the Workplace

For Your Review Read Chapters 9, 10, and 12 of Emergency Care, then complete the following activities.

Key Terms Referring to Emergency Care , define the following terms:

Arteries: ______

Bandage: ______

Blast injury: ______

Blood volume: ______

Burn: ______

Capillaries: ______

Closed wound: ______

Clotting: ______

Critical burn: ______

Crush injury: ______

Dermatitis: ______

Direct pressure: ______

Dressing: ______

External bleeding: ______

Full-thickness burn: ______

Gangrene: ______

Hemorrhage: ______

Internal bleeding: ______

Open wound: ______

Partial-thickness burn: ______Copyright Copyright © The 2012 Canadian Red Cross Society Emergency Care Workbook 51 Pressure bandage: ______

Shock: ______

Soft tissues: ______

Subungual hematoma: ______

Superficial burn: ______

Tourniquet: ______

Veins: ______

Wound: ______

Do You Know… 5. Matching 1. List the components of blood. Draw a line to match each type of shock, on the left,with its cause, on the right. i. ______TYPE CAUSE ii. ______Neurogenic Failure of the heart to effectively pump iii. ______blood to all parts of the body iv. ______Psychogenic Severe lack of blood and fluid in the body 2. List the three major functions of blood. Septic Factors such as emotional stress cause i. ______blood to pool in the body in areas away Anaphylactic ii. ______from the brain because of vessels dilating iii. ______Cardiogenic Poisoning caused by severe infections that cause blood vessels to dilate 3. List the signs and symptoms of severe internal Hypovolemic bleeding. Life-threatening allergic reaction to a substance Respiratory Failure of the lungs to transfer sufficient oxygen into the bloodstream Failure of the nervous system to control the size of blood vessels, causing them to dilate 4. List five things you can do to care for shock. i. ______ii. ______iii. ______iv. ______v. ______Copyright Copyright © The 2012 Canadian Red Cross Society Emergency Care Workbook 52 6. List at least six signs and symptoms of shock. Fill in the Blanks Underline the two that are the best early indicators 1. Estimating the Extent of Burns of shock. On the diagrams below, write the percentages that correspond to the various body areas, to represent the percentage of body surface burned.

7. Using the diagram below, draw what you would do to care for this person. To the side of the diagram, describe any other care you would give that cannot be drawn on the diagram.

2. Thicknesses of Burns 8. What are the four main types of open wounds? Using the diagram below, list the two layers of skin. Next, indicate which layers are affected by each of i. ______the three thicknesses of burns by drawing an arrow ii. ______through the correct layers. iii. ______iv. ______Copyright Copyright © The 2012 Canadian Red Cross Society Emergency Care Workbook 53 What Would You Do? a. He may be losing blood internally, and his heart Read the following scenarios and answer the questions is compensating for this by beating faster below. b. He has a severe infection that is affecting his car- diovascular system Scenario 1 c. He is mad at the driver for hitting him, and his You respond to a call to an open field at a rural worksite, stress level is high where a man was burning off fence posts and debris d. Nothing is wrong, as these vital signs are normal from a workshop. He threw some debris in the fire, and, for a male teenager shortly after, there was an explosion. An aerosol can must have gotten mixed in with the material he was 2. What steps would you take to care for the co-worker? burning. He was hit by flying debris and thrown, landing forcefully. As you approach, you notice he is lying on his back, looking anxious and in pain, with a large wound in his left leg, which seems to be bleeding uncontrollably. 3. When you take the next set of vital signs, his pulse Your partner takes spinal precautions. is 150, weak, and rapid, his breathing is ineffective 1. Before applying direct pressure to the wound, you and at a rate of 30 times per minute, and his blood should: pressure is 74/42. When you assess his level of con- a. Ensure you have gloves on sciousness, he does not respond to your voice. What b. Check his vital signs is the next step to take? c. Ask SAMPLE questions a. Shake him to wake him up d. Conduct a secondary survey b. Increase the flow of oxygen c. Apply a painful stimulus and look for a response 2. While you are conducting a secondary survey, you d. Take note of this and move on to checking his notice the man is getting drowsy and is complain- pupils ing of thirst and nausea. You expose his abdomen and notice it is bruised and swollen. This would 4. The teenager begins to gasp for air and then stops indicate: breathing. You reassess his ABCs and find he is in a. He has been doing a lot of sit-ups lately cardiac arrest. What is your next step? b. He has eaten something recently that has made a. Take his blood pressure him sick b. Recheck his vital signs c. He is bleeding internally c. Suction the airway and then increase oxygen d. He was burned by the fire flow d. Begin CPR/AED 3. What other care would you give for this man? Scenario 3 You are called to the warehouse at your workplace, where one of your co-workers was trying to remove something jammed in the cardboard baler. He got the jam out but did not get his hand out in time, and his Scenario 2 hand has been amputated. He is lying on the concrete You are called to the scene of a forklift collision where floor, conscious and in severe pain. one co-worker, a teenager, was hit in the thigh while 1. After ensuring you have the appropriate personal transferring materials across the floor. The driver of the protective equipment on, what should your next vehicle is speaking with the shift supervisor. You find the step be? teenager lying on his back on the ground, propped up on a. Perform a secondary survey and look for any one elbow, wincing in pain. other injuries 1. You take a set of vital signs and find his pulse to be b. Pack the area where the hand was with dress- 130, weak, and rapid, and he has a blood pressure ings of 86/58. This most likely indicates: c. Take a set of vital signs d. Get the hand out of the baler Copyright Copyright © The 2012 Canadian Red Cross Society Emergency Care Workbook 54 2. Which of the following conditions will the person Test Your Knowledge likely develop shortly? Circle the best answer to each of the following questions. a. Shock 1. A sign of severe external bleeding is: b. Hemothorax a. Blood oozing from a wound c. Angina b. Blood that fails to clot after you have tried to d. Infection control it 3. What four things should you do to the amputated c. Blood spurting from a wound hand to increase the chances of successful re- d. Both b and c attachment? 2. Which is NOT involved in the care for severe inter- i. ______nal bleeding? a. Obtain more advanced medical care ii. ______b. Administer supplemental oxygen iii. ______c. Give the person sips of water d. Treat the person for shock iv. ______3. What are the three types of vessels that carry Scenario 4 blood? An older female cook slips in the cafeteria in your work- a. Arteries, capillaries, and veins place. As she falls, she reaches out and her hand hits the b. Arteries, alveoli, and veins handle of a pot on the stove. The pot, in which potatoes c. Atria, capillaries, and ventricles were being boiled, flips off the stove, and the water lands d. Arteries, bronchioles, and veins on the woman, scalding her. 4. If a person has severe blood loss, the blood pres- 1. You note that she has partial-thickness burns cover- sure should: ing her face and left arm. She has superficial burns a. Go up to her right arm. Estimate the percentage of her b. Drop body that has been burned. c. Remain normal a. 9% d. Demonstrate an increasing gap between the sys- b. 18% tolic and the diastolic pressure c. 27% d. 36% 5. If blood is uncontrollably spurting from a wound, which of the following personal protection items 2. How will you care for these burns? should you wear? a. Get her to lie in a tub of ice water a. Gloves b. Put cold cloths over the entire burned area b. Gown c. Put ice on the areas that are the most severely c. Protective eyewear and mask burned d. All of the above d. Cool the burns immediately to prevent further burning and decrease pain 6. If a person is severely bleeding internally from a fall, which of the following personal protection 3. This is considered to be a critical burn, and you items should you wear? should obtain more advanced medical care. T or F a. Gloves 4. After cooling, what should be put on the burns to b. Gown keep out air and reduce pain? c. Protective eyewear and mask a. Non-stick sterile dressings d. All of the above b. Sterile occlusive dressings c. Nothing d. More cool cloths Copyright Copyright © The 2012 Canadian Red Cross Society Emergency Care Workbook 55 7. If direct pressure and pressure bandages do not 13. Which of the following is NOT included in the gen- stop the bleeding, which of the following can be eral care for shock? used as a last resort, by trained personnel only? a. Administer oxygen a. Arterial clamping b. Maintain normal body temperature b. Tourniquet c. Give assisted ventilations c. Elastic bandaging d. Provide rest and reassurance d. Hyperbaric recompression 14. You have to identify the specific nature of the ill- 8. Shock is life-threatening because: ness or injury before you can provide care for shock. a. The blood becomes poisonous T or F b. The vital organs are not getting adequate 15. If an injury causes severe blood loss, this will in turn oxygen-rich blood cause: c. There is not enough blood in the circulatory sys- a. The blood pressure to increase tem b. The skin to become red and warm d. Carbon dioxide is not being released from the c. The heart rate to drop tissues in large enough quantities d. The blood volume to drop 9. Why does the skin of someone in shock appear pale 16. Do not wait for shock to develop before providing and feel cool? care. T or F a. The heart beats faster; therefore, the body’s heat is used as energy 17. Why is it important to help someone with shock to b. The heart slows down; therefore, less heat is pro- rest comfortably? duced a. It may minimize pain c. The blood vessels constrict in the arms, legs, and b. It reduces the workload on the heart skin c. It allows the blood vessels to constrict d. The body cools itself to conserve energy d. Both a and b 10. Which of the following situations is likely to lead to 18. Which of the following is NOT a step in caring for shock? an abrasion? a. A teenager damages her spine in a diving inci- a. Place a sterile dressing over the wound dent b. Apply ice to the wound b. A worker loses his arm in a piece of farming c. Cleanse the wound with soap and water equipment d. Rinse the wound under running water c. A child who has the flu has been unable to keep 19. What is the purpose of a bandage? fluids down for several days a. It prevents air from reaching the wound and d. All of the above keeps dressings in place 11. In cases of serious illness or injury, shock is usually b. It provides a sterile covering for the wound the final stage before death. T or F c. It applies pressure to control bleeding and sup- ports injured body parts 12. Someone in shock should be positioned: d. It allows the wound to breathe and prevents a. On her back with the head elevated infection b. Flat on her back c. Sitting in a chair 20. If someone has been struck by lightning, which of d. On a long backboard the following injuries might you suspect? a. Burns b. Spinal injuries c. Entry and exit wounds d. All of the above Copyright Copyright © The 2012 Canadian Red Cross Society Emergency Care Workbook 56 21. If a person has a burn that is black and charred with 25. A myocardial contusion is: white tissue in the middle, this is a: a. A bruise to the heart a. Superficial burn b. Any bruise located in the torso area b. Partial-thickness burn c. Any soft tissue injury to the heart c. Full-thickness burn d. A rupture of any of the major vessels supplying d. None of the above blood to the heart 22. If you bandage a forearm, you should leave the fin- 26. The area around a recent wound is now red and gers of the hand exposed. T or F swollen. The area feels warm to the touch. This may indicate: 23. A woman has dropped a chemical powder on her a. A quick healing process foot, causing a chemical burn. You should first: b. Severe internal bleeding a. Brush the dry chemicals off the foot using a c. An infection gloved hand d. A superficial burn b. Cool the area with cool running water c. Apply a cold compress to the area 27. Which is NOT one of the mechanisms of injury from d. Cover the area with a non-stick sterile dressing a blast? a. Shrapnel thrown by the blast 24. You should obtain more advanced medical care in b. Poisoning due to fumes released by the blast which of the following situations: c. Trauma due to being thrown by the blast a. A 35-year-old man with a full-thickness burn on d. Injury due to the pressure wave or heat of the his hand blast b. A 7-year-old child with a sunburn on his back c. A 72-year-old woman with a blistered burn on her leg d. Both a and c Copyright Copyright © The 2012 Canadian Red Cross Society Emergency Care Workbook 57